Individual
MARY JO WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
315 W 57TH ST, SUITE 402, NEW YORK, NY 10019-3158
(212) 757-6607
(212) 757-2932
Mailing address
484 W 43RD ST, 44-M, NEW YORK, NY 10036-6319
(212) 564-1174
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
010284
NY
Other
Enumeration date
04/08/2007
Last updated
07/08/2007
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